Healthcare Provider Details

I. General information

NPI: 1972896090
Provider Name (Legal Business Name): JO CARNEY DEATON APRN/PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY-JOAN DEATON

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WOODLAWN AVE APT. A
CATONSVILLE MD
21228-3431
US

IV. Provider business mailing address

22 WOODLAWN AVE APT. A
CATONSVILLE MD
21228-3431
US

V. Phone/Fax

Practice location:
  • Phone: 443-928-3978
  • Fax:
Mailing address:
  • Phone: 443-928-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR062724
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: